A new report says there are 1,200 doctors working in the health system where there is a lack of clarity around their career structure and role.
It also recommends that the appointments system for consultants be redesigned and modernised, to balance local autonomy, as well as national coordination.
The report says that the current consultant appointment process is too protracted and can take 18 months.
The aim would be to reduce this to around three months.
The report says there are 2,708 consultant posts and there were 977 new appointments over the past decade.
The recommendations are contained in the final report of the Strategic Review of Medical Training & Career Structure, published today.
Two other reports were published in December 2013 and April this year.
The group was chaired by Professor Brian MacCraith, President of Dublin City University.